Hip pain while sleeping on your side is a common problem. It may make it difficult to fall asleep, wake you during the night or leave the outside of the hip sore the following morning.
Although this discomfort is frequently called “hip bursitis,” pain at night does not always originate from an inflamed bursa. The hip’s tendons, muscles, joints and surrounding nerves can all contribute to pain. Lower-back conditions can also send pain into the hip or buttock.
The location of the discomfort, movements that aggravate it and accompanying symptoms can help identify the likely cause. A clinical evaluation is important when pain persists, interferes with walking or prevents restful sleep.
The location of the pain provides useful information.
Pain directly over the bony prominence on the side of the hip commonly involves the gluteal tendons and nearby bursa. This area may be tender when pressed or compressed against a mattress.
The discomfort may extend along the outside of the thigh but usually does not travel below the knee.
Groin pain can be associated with the hip joint itself. Arthritis, joint irritation, a labral problem or another condition affecting the joint may cause pain when walking, turning, bending or getting out of a chair.
Pain toward the back of the hip may originate from muscles, tendons, the sacroiliac region or the lumbar spine.
If the discomfort travels down the leg or is accompanied by numbness, tingling or weakness, a spinal nerve may be involved. Learn more on our Back Pain page.
Greater trochanteric pain syndrome, or GTPS, is a common cause of pain on the outside of the hip. The greater trochanter is the bony prominence that can be felt along the side of the upper thigh.
Several muscles and tendons attach near this area. Fluid-filled sacs called bursae reduce friction between the tissues. Pain may develop when the gluteal tendons, bursae or surrounding structures become irritated.
Symptoms may include:
Tenderness on the outside of the hip
Pain when lying on the affected side
Discomfort while walking or climbing stairs
Pain when standing on one leg
Difficulty getting up from a low chair
Pain after prolonged standing
Aching along the outside of the thigh
Increased symptoms after a change in physical activity
GTPS is broader than bursitis because the tendons are frequently involved along with, or instead of, the bursa.
Side sleeping places direct pressure on the tissues covering the outside of the hip. If these tissues are already sensitive, several hours of compression can increase discomfort.
The position of the top leg can also matter. When the top knee drops forward and across the body, the hip moves inward. This position may increase tension through the gluteal tendons and surrounding tissues.
A mattress that is extremely firm may create more pressure over the bony side of the hip. However, an excessively soft mattress may allow the pelvis and spine to sink into an uncomfortable position. Mattress preference varies, and replacing the mattress does not correct every underlying cause of nighttime hip pain.
Yes. The gluteus medius and gluteus minimus tendons help stabilize the pelvis while standing and walking. Irritation or degeneration of these tendons can cause pain on the outside of the hip.
Possible symptoms include:
Pain when lying on either side
Tenderness over the outer hip
Pain while climbing stairs
Discomfort during prolonged walking
Pain when standing on one leg
Difficulty carrying weight on one side
Hip weakness or a feeling of instability
Tendon pain does not necessarily mean that the tendon is completely torn. The severity and cause should be determined through an appropriate examination.
Hip arthritis can cause aching, stiffness and reduced movement. Pain is often felt in the groin but may also be experienced in the thigh, buttock or knee.
Possible signs of hip arthritis include:
Morning stiffness
Difficulty putting on socks or shoes
Pain when getting into or out of a car
Reduced ability to rotate the hip
Discomfort after prolonged walking
Stiffness after sitting
Grinding or catching sensations
Progressive limitation of activity
Arthritis-related pain may become noticeable at night, particularly after an active day. However, nighttime pain alone does not confirm arthritis.
Yes. A problem in the lumbar spine can produce pain in the buttock, side of the hip or leg. This is known as referred pain when the hip hurts even though the source is elsewhere.
A spinal nerve problem may cause:
Pain traveling below the hip
Burning or electric sensations
Numbness or tingling
Leg weakness
Pain affected by sitting, bending or standing
Symptoms extending below the knee
Lower-back pain occurring with hip pain
A physical examination can help distinguish hip-joint pain, soft-tissue pain and pain referred from the lower back.
The sacroiliac joints connect the pelvis to the lower spine. Irritation in this region can produce pain near the lower back, upper buttock or back of the hip.
Symptoms may worsen while:
Turning in bed
Standing from a seated position
Climbing stairs
Walking with an uneven stride
Standing primarily on one leg
Moving after prolonged sitting
Sacroiliac-region pain may resemble hip pain, so the diagnosis should not be based only on where the patient feels discomfort.
A fall, direct impact, sudden twisting movement or increase in exercise can injure the hip’s muscles, tendons, bones or joint structures.
Medical evaluation is especially important when pain begins after trauma. Older adults and people with osteoporosis may sustain a fracture even after a relatively minor fall.
Pain after an injury should not automatically be treated as bursitis or muscle tightness.
An evaluation generally begins with a discussion of:
The exact location of the pain
When the symptoms began
Whether an injury occurred
Which sleeping positions aggravate the pain
Whether pain occurs during walking or stair climbing
Whether symptoms travel down the leg
The presence of numbness, tingling or weakness
Previous hip, back or joint problems
Recent changes in exercise, work or daily activity
The examination may assess hip movement, tenderness, muscle strength, walking pattern, balance and the effect of spinal movement on the symptoms.
The clinician may also examine the lower back, pelvis and knee because pain from these areas can be perceived near the hip.
Imaging is not required for every episode of hip pain.
An X-ray may be considered when arthritis, fracture or another bone-related condition is suspected. Ultrasound or MRI may be appropriate when symptoms and examination findings suggest a significant tendon injury or another soft-tissue problem.
Imaging results must be interpreted together with the patient’s symptoms and examination. Age-related findings can appear on scans even when they are not the primary cause of pain.
Physical therapy may address factors contributing to hip pain rather than focusing only on the painful area.
Depending on the diagnosis, treatment may include:
Gradual hip-strengthening exercises
Gluteal muscle rehabilitation
Core and pelvic stabilization
Gait and balance training
Mobility exercises
Activity modification
Education about sleep positioning
Guidance for returning to walking or exercise
Treatment of contributing lower-back dysfunction
Exercises should be selected according to the patient’s diagnosis, current ability and response to movement. A program that is appropriate for one type of hip pain may aggravate another.
A rehabilitation program may include:
Controlled hip-abduction exercises
Bridging variations
Sit-to-stand training
Side-stepping exercises
Core-stability work
Balance exercises
Gradual walking
Functional strengthening for stairs
Mobility exercises for the hip or lower back
Exercise should progress gradually. Repeatedly compressing or aggressively stretching a painful outer hip may worsen symptoms in some patients.
An individualized program is preferable when pain is persistent or the diagnosis is uncertain.
Acupuncture may be considered as part of a broader treatment plan for certain musculoskeletal pain conditions.
Treatment is individualized according to the diagnosis, pain pattern, medical history and examination. It may be combined with physical therapy, exercise and other appropriate care when the goal is to reduce pain and improve function.
Patients interested in acupuncture can learn more about Roman Slavinskiy, L.Ac..
Injection-based treatment may be considered when examination and imaging findings identify an appropriate target and conservative care has not provided sufficient improvement.
The type of injection depends on the actual source of pain. An injection intended for an irritated bursa is different from treatment directed toward the hip joint or another structure.
Not every patient needs an injection, and temporary pain relief does not replace rehabilitation when weakness, altered movement or activity-related overload is contributing to the condition.
Until the condition is evaluated, some people may be more comfortable using the following adjustments:
Avoid lying directly on the painful hip
Place a pillow between the knees when side sleeping
Keep the knees and hips aligned instead of allowing the top leg to fall forward
Try sleeping on the back with a pillow under the knees
Change positions periodically
Avoid remaining in a painful position for long periods
Use a mattress surface that supports the body without creating excessive pressure
These strategies may reduce irritation, but they do not identify or correct the underlying cause.
Reasonable short-term measures may include:
Reducing activities that clearly increase pain
Avoiding prolonged standing on one leg
Temporarily limiting repeated stair climbing
Taking breaks from prolonged sitting
Maintaining comfortable movement rather than complete inactivity
Using cold or heat if medically appropriate
Returning to activity gradually
Medication is not appropriate for everyone. Patients should ask a qualified healthcare professional before using pain relievers, particularly if they have kidney disease, gastrointestinal problems, cardiovascular conditions, medication interactions or other relevant health concerns.
Schedule an evaluation when:
Pain repeatedly interrupts sleep
Symptoms continue or worsen
Walking becomes difficult
The hip feels weak or unstable
Pain interferes with stairs or daily activity
Symptoms began after a fall or work injury
Pain extends into the leg
Numbness or tingling develops
Home measures are not helping
The diagnosis is uncertain
Patients whose symptoms began during work can also review our Work-Related Injuries page.
Seek prompt medical attention for:
Inability to stand or bear weight
Severe pain after a fall
Visible hip or leg deformity
Sudden major swelling
A hot, red joint accompanied by fever
An open wound near the joint
New significant leg weakness
Loss of bladder or bowel control
Numbness around the groin or saddle region
Chest pain or shortness of breath
A cold, pale or discolored leg
Rapidly worsening symptoms
These findings should not be managed solely with home exercises or sleep-position changes.
Brooklyn Pain Doctors provides multidisciplinary evaluation and treatment for patients experiencing hip pain, outer-hip tenderness, joint pain, lower-back-related symptoms and other musculoskeletal conditions.
Depending on the diagnosis and individual needs, treatment may include physical therapy, acupuncture, electroacupuncture, pain-management evaluation, therapeutic exercise, injection-based treatment or other appropriate care available within the practice.
Learn more about the practice’s approach to musculoskeletal conditions on our Joint Pain page.
Brooklyn Pain Doctors is located at:
1720 East 14th Street
Brooklyn, NY 11229
Call 718-338-6655 to schedule an evaluation and determine which treatment approach may be appropriate for your hip pain.
This article is for general educational purposes and is not a substitute for individualized medical evaluation, diagnosis or treatment. Treatment recommendations depend on the patient’s symptoms, examination, medical history and diagnosis.